Healthcare Provider Details

I. General information

NPI: 1659974103
Provider Name (Legal Business Name): JIGISHA MEHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13490 NEW HAMPSHIRE AVE
COLESVILLE MD
20904-1224
US

IV. Provider business mailing address

158 PRADO LN
CLARKSBURG MD
20871-6315
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-2228
  • Fax:
Mailing address:
  • Phone: 301-538-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18831
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: